Acute Stroke Management: Capturing the Walk-In Patient

Abstract

Session J presented Saturday, September 29, 11:30 am-12:30 pm pm Purpose: The journey to comprehensive stroke certification identified opportunities for improvement in the treatment of stroke patients in the ED. This allowed the team to examine the process of care delivery and missed opportunities. One missed opportunity is the walk in stroke patient. This project created a process to identify a stroke patient at arrival and decrease time to stroke notification call. Design: This initiative looked at the quality of care provided and established benchmarks of arrival to stroke team notification and door to CT scan for acute stroke patients. This was a staff development and quality assurance project to enhance quality of our walk in stroke patients. This project allowed for better outcomes and future success in the care of stroke patients. Setting: Urban, teaching, comprehensive stroke center and Level I trauma center Participants/Subjects: All ED nurses and physicians worked on this project. Methods: Striving for excellence through comprehensive stroke certification the team embarked on a journey to decrease the door to Stroke activation time for walk in stroke patients. A thorough assessment of the complex process was completed and it was recognized that the delay was related to symptom recognition and presentation to the physician. The multidisciplinary team identified ways and processes to streamline the intake process and MD presentation. Education was provided to all staff and mock drills were used to hardwire the process. Results/Outcomes: The door to Code Stroke activation decreased from 19 minutes(2016) to 15 minutes (2017). This allowed for door to CT complete to drop from 50 minute to 29 minutes(20-17). Implications: An efficient high performing team will result in safe quality patient care. This team showed that utilizing team performance principles, success can be achieved. The team is now working on decreasing the door to needle goal even further to 45 minutes 100% of the time.